BILL ANALYSIS Ó
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UNFINISHED BUSINESS
Bill No: SB 659
Author: Negrete McLeod (D)
Amended: 6/15/12
Vote: 21
SENATE VOTES NOT RELEVANT
ASSEMBLY FLOOR : 79-0, 8/16/12 (Consent) - See last page
for vote
SUBJECT : Immunizations: disclosure of information:
tuberculosis
screening
SOURCE : Health Officers Association of California
DIGEST : This bill adds tuberculosis (TB) screening
results to the information that may be disclosed from a
patient's medical record to the Department of Public Health
(DPH) and local health departments (LHDs) operating
countywide or regional immunization information and
reminder systems, and defines TB screening as an approved
intradermal tuberculin test or any other test for
tuberculosis infection that is recommended by the federal
Centers for Disease Control (CDC) and Prevention and
licensed by the federal Food and Drug Administration.
Assembly Amendments delete the Senate version of the bill
regarding community development, and implement the current
language regarding tuberculosis screening.
CONTINUED
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ANALYSIS :
Existing law:
1. Permits LHDs to operate immunization information systems
in conjunction with DPH either separately within their
individual jurisdictions, jointly among more than one
jurisdiction, or both.
2. Permits health care providers and other agencies to
disclose specified information from a patient's medical
record to DPH and LHDs operating countywide or regional
immunization information and reminder systems. Permits
LHDs and DPH to disclose this information with each
other, and, upon a request for information pertaining to
a specific person, to health care providers taking care
of the patient.
3. Specifies the purposes for which LHDs and DPH are
permitted to disclose specified information from a
patient's medical record, upon request, to each other
and other specified agencies.
4. Requires health care providers and other agencies to
maintain the confidentiality of medical record
immunization information. Permits civil action and
criminal penalties for the wrongful disclosure of such
information. Prohibits a health care provider or other
agency from sharing medical record information with an
immunization system if the patient or client, or parent
or guardian of the patient or client refuses.
This bill adds TB screening results to the information that
may be disclosed from a patient's medical record to DPH and
LHDs operating countywide or regional immunization
information and reminder systems, and defines TB screening
as an approved intradermal tuberculin test or any other
test for TB infection that is recommended by the CDC and
licensed by the federal Food and Drug Administration.
Comments
According to the author's office, TB screening results are
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currently collected by physicians and provided to patients
(and/or their parents) on the same document as immunization
information (commonly known as yellow cards). TB testing
results, however, are not as readily available as
immunization records. The medical provider either has to
re-enter (by hand) the TB screening results on the yellow
card each time they print out a new card from an
immunization registry, or have the parents keep the old
yellow cards as a record of the TB screening results.
Background
TB . According to the CDC, TB is a contagious disease
caused by germs that are spread through the air and usually
affects the lungs, but it can also affect other parts of
the body, such as the brain, the kidneys, or the spine.
The general symptoms of TB include feelings of sickness or
weakness, weight loss, fever, and night sweats. Other
symptoms include coughing, chest pain, and the coughing up
of blood. According to DPH, in 2008, California had the
second highest annual TB incidence rate in the nation: 7.0
cases per 100,000 people, compared to the national average
of 4.2 cases per 100,000 people. Of the 13,000 cases of TB
reported in the United States in 2008, 21% were reported in
California. Following a large increase in TB in the late
1980s and early 1990s, state, local, and national
tuberculosis control efforts were strengthened.
Subsequently, the TB case rate in California declined 50%
between 1992 and 2008. However, the annual rate of decline
has slowed significantly and was just 1% in 2007-08.
Immunization registries . All 50 states have an
immunization registry. In California, DPH operates the
California Immunization Registry (CAIR). According to CAIR,
it consists of 10 regional immunization registries (mostly
county regions), which provide a computerized system
intended to assist providers to track patient records,
reduce missed opportunities, and help fully immunize
Californians of all ages. Providers use web-based registry
software to enter immunization data or may opt to exchange
data via their existing electronic medical records system.
Other agencies, such as schools, child care centers, and
the Women, Infants and Children Program or WIC may also
participate in CAIR. CAIR allows access to immunization
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data from other participating providers in California. In
the coming years, CAIR will integrate its existing regional
databases and data may be securely exchanged across all
areas of California. When fully integrated, CAIR will
provide the state with the data to assess immunization
coverage rates, identify pockets of need, and analyze how
best to ensure full immunization coverage for the state.
Related Legislation
The June 16, 2011 version of SB 922 (Negrete McLeod) was
substantially similar to the provisions of this bill and
would have added TB screening results to the list of
information that may be collected and disclosed through the
state's immunization registry system. Amendments were
taken to remove these provisions and change the author to
SB 922 (Steinberg, Chapter 431, Statutes of 2011), and
require that all project labor agreements (PLAs)
incorporate specified provisions, and prohibits state
funding assistance, after January 1, 2015, on public works
projects of charter cities having ordinances prohibiting
the use of PLAs.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 8/17/12)
Health Officers Association of California (source)
Santa Clara County Board of Supervisors
ARGUMENTS IN SUPPORT : The Health Officers Association of
California (HOAC) writes that not being able to collect TB
screening results in CAIR is a time-consuming endeavor for
providers and an inconvenience for parents. HOAC states
that allowing CAIR to record these results will have the
added benefit of helping schools to expedite the
registration of students, as they could be reviewed at the
same time school personnel are reviewing immunization
information.
ASSEMBLY FLOOR : 79-0, 8/16/12
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Beall,
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Bill Berryhill, Block, Blumenfield, Bonilla, Bradford,
Brownley, Buchanan, Butler, Charles Calderon, Campos,
Carter, Cedillo, Chesbro, Conway, Cook, Davis, Dickinson,
Donnelly, Eng, Feuer, Fletcher, Fong, Fuentes, Furutani,
Beth Gaines, Galgiani, Garrick, Gatto, Gordon, Gorell,
Grove, Hagman, Halderman, Hall, Harkey, Hayashi, Roger
Hernández, Hill, Huber, Hueso, Huffman, Jeffries, Jones,
Knight, Logue, Bonnie Lowenthal, Ma, Mansoor, Mendoza,
Miller, Mitchell, Monning, Morrell, Nestande, Nielsen,
Norby, Olsen, Pan, Perea, V. Manuel Pérez, Portantino,
Silva, Skinner, Smyth, Solorio, Swanson, Torres, Valadao,
Wagner, Wieckowski, Williams, Yamada, John A. Pérez
NO VOTE RECORDED: Lara
CTW:m 8/17/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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